Healthcare Provider Details

I. General information

NPI: 1427046994
Provider Name (Legal Business Name): RAYMOND A BEDGOOD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 HIGHLAND PARK LOOP
PINE MOUNTAIN GA
31822-2586
US

IV. Provider business mailing address

404 HIGHLAND PARK LOOP
PINE MOUNTAIN GA
31822-2586
US

V. Phone/Fax

Practice location:
  • Phone: 706-483-2333
  • Fax:
Mailing address:
  • Phone: 706-483-2333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37955
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: